Vats A, Pettignano R, Culler S, Wright J
Division of Critical Care Medicine, Egleston Children's Hospital at Emory University, Atlanta, GA, USA.
Crit Care Med. 1998 Sep;26(9):1587-92. doi: 10.1097/00003246-199809000-00032.
To determine the impact of extracorporeal life support (ECLS) on mortality in pediatric patients with acute hypoxemic respiratory failure (AHRF) at our institution; and to calculate the hospital charges associated with the use of ECLS.
Retrospective review of medical records and hospital charges.
Pediatric intensive care unit (ICU) of a university-affiliated children's hospital.
Twenty patients admitted to the pediatric ICU between 1991 and 1995 for AHRF who received ECLS as a part of their hospital course.
Predicted mortality was calculated using the Pediatric Respiratory Failure score and was compared with survival at the time of hospital discharge. Hospital charges were used as a proxy for resource utilization. Cost-per-life-year-saved calculations were performed based on a normal life expectancy for survivors.
Twenty patients were identified. The median age was 4.83 yrs. The median duration of ECLS was 9 days, with 19.5 days in the pediatric ICU and 23.5 days for the entire hospital length of stay. The observed mortality rate for these patients was 20%. Median predicted mortality rate based on the Pediatric Respiratory Failure score calculation was 83%. The hospital charges incurred by these patients was a median of $199,096. Based on a normal life expectancy for survivors, this results in a cost of $4,190/life-year.
ECLS for the pediatric patient with AHRF is done at a considerable cost. However, ECLS affects survival favorably, and compares favorably when considering cost/life-year calculations. The data presented in this study may serve as a benchmark for comparison with newer therapies (i.e., liquid ventilation, nitric oxide). These data also provide a framework for cost-based analyses at other ECLS institutions.
确定体外生命支持（ECLS）对我院儿科急性低氧性呼吸衰竭（AHRF）患者死亡率的影响；并计算与使用ECLS相关的医院费用。
对病历和医院费用进行回顾性分析。
一所大学附属医院的儿科重症监护病房（ICU）。
1991年至1995年间因AHRF入住儿科ICU并接受ECLS治疗的20例患者，ECLS作为其住院治疗过程的一部分。
使用儿科呼吸衰竭评分计算预测死亡率，并与出院时的生存率进行比较。医院费用用作资源利用的替代指标。根据幸存者的正常预期寿命进行每挽救一个生命年的成本计算。
确定了20例患者。中位年龄为4.83岁。ECLS的中位持续时间为9天，在儿科ICU的中位时间为19.5天，整个住院期间的中位时间为23.5天。这些患者的观察到的死亡率为20%。根据儿科呼吸衰竭评分计算得出的中位预测死亡率为83%。这些患者产生的医院费用中位数为199,096美元。根据幸存者的正常预期寿命，这导致每挽救一个生命年的成本为4,190美元。
对患有AHRF的儿科患者进行ECLS治疗成本高昂。然而，ECLS对生存有积极影响，在考虑成本/生命年计算时表现良好。本研究中呈现的数据可作为与新疗法（如液体通气、一氧化氮）进行比较的基准。这些数据还为其他ECLS机构基于成本的分析提供了框架。
